Gynecologic Flashcards
(75 cards)
1
Q
What tanner stage for women? Areola and nipple project as secondary mound
A
stage 4
2
Q
What tanner stage for women? Preadolescent breasts
A
stage 1
3
Q
What tanner stage for women? Breast enlargement without separate nipple contour
A
stage 3
4
Q
What tanner stage for women? Breast buds with areolar enlargement
A
stage 2
5
Q
What tanner stage for women? Areola recedes, nipple retracts
A
stage 5
6
Q
Example of primary amenorrhea
A
Absence of menarche by age 16
7
Q
Primary or secondary? Cessation of menstrual flow after the establishment of normal menstrual cycling
A
secondary
8
Q
Absence of menarche, absence of secondary sex characteristics, abnormal growth and development
A
primary amenorrhea
9
Q
Diagnosis test for amenorrhea
A
pregnancy test, refer to endocrinologist/obgyn, referral for other studies
10
Q
Risk factors for cervical cancer
A
HPC (early, multiple sexual partners), male partner who has had multiple sexual partners, cigarette smoking, NOT HEREDITARY
11
Q
BETHESDA classification system
A
- ASCUS
- Low-grade squamous intraepithelial lesion (LSIL or LGSIL)
a. Cervical intraepithelial neoplasia (CIN 1): HPV or mild dysplasia - High-grade squamous intraepithelial lesions (HSILor HGSIL)
a. CIN 2: moderate dysplasia
b. CIN 3: Severe dysplasia - Carcinoma in situ (CIS)
- Squamous cell carcinoma
12
Q
Management if pap result is: infection
A
treatment based on causative agent; repeat PAP 3-4 months after treatment
13
Q
Management of ASCUS
A
“watch and repeat”
HPV test, repeat PAP smear
14
Q
Management of LSIL and up
A
Colposcopy. Refer if CIN 2,3, or CIS
15
Q
Top Killers of adults in the US
A
- Heart disease
- Cancer
- Unintentional injury
- low respiratory disease
- CVA
16
Q
Cancer in women: responsible for the highest mortality?
A
Lung
17
Q
Cancer in women: leading GYN-associated cancer “killer”
A
Ovarian
18
Q
Cancer in women: highest incidence other than skin cancer?
A
Breast
19
Q
Cancer in men: highest mortality?
A
Lung
20
Q
2nd most common cancer in men and #2 cancer killer?
A
Prostate
21
Q
Men and women leading cancer killer?
A
Lung
22
Q
Second leading cancer killer for men and women?
A
Colorectal
23
Q
when do we stop screening for cervical cancer?
A
> 65 years (for patients with adequate negative prior screening and no history of CIN2 or higher within the last 25 years)
24
Q
How often do we screen cytology for cervical cancer age 21-29?
A
cytology alone every 3 years. HPV test every 5 years preferred
25
Patients aged 30-65 years, how often can we do co-testing?
Q5 years is acceptable
26
Inflammation or infection of the vulva and vagina most commonly caused by bacteria, protozoa, and/or fungi
vulvovaginitis
27
Symptom of trichomoniasis in men:
often asymptomatic;
malodorous, frothy yellowish-green discharge
28
what infection? Strawberry patches on cervix and vagina
Trichomoniasis
29
What infection? watery, gra, "fishy" smelling discharge
Bacterial vaginosis
30
What infection? Frothy yellowish-green discharge, pruritus
Trichomoniasis
31
Vulvovaginal erythema with pruritus, thick white curd-like discharge
candidiasis
32
what infection? normal caline muxture shows irregularly-shaped vaginal epithelial cells (i.r. clue cells)
bacterial vaginosis
33
what infection? KOH mixture show pseudohyphae
Candidiasis
34
What infection? potassium hydroxide added to culture produces characteristic odor (i.e. whiff test)
bacterial vaginosis
35
what infection? motile trichomonads
trichomoniasis
36
Management of trichomoniasis (men and women)
Metronidazole (women 500 mg BID for 7 days; men 2 g single dose)
37
What should patients avoid when taking Metronidazole?
avoid drinking alcohol
38
Management of bacterial vaginosis
Metronidazole 500 mg BID for 7 days OR metronidazole gel 0.75% intravaginally once a day for 5 days OR clindamycin cream 2% intravaginally at bedtime for 7 days
Alternative: Tinidazole 2 grams orally once a day for 2 days OR tinidazole 1 gram orally once daily for 5 days OR CLindamycin 300 mg BID for 7 days OR clindamycin ovules 100 mg intravaginally once at bedtime for 3 days OR Secnidazole 2 grams orally in a single dose, taken with soft food
39
Management of candidiasis
OTC intraveginal agents: clotrimazole, miconazole or tioconazole intravaginally or as a vaginal suppository. Precription intravaginal agents: butoconazole or terconazole intravaginally or as a vaginal suppository
40
What are the symptoms of PID?
fever/chills, n/v, vaginal discharge, dysuria, dyspareunia, lower abdominal pain, INFERTILITY
41
What finding is positive cervical motion tenderness?
PID
42
What finding is adnexal tenderness, abdominal tenderness, fever >38 degress Celsius?
PID
43
Diagnostic tests for PID
STD testing, elevated ESR or C-reactive protein, ultrasound documentation of ovarian cyst
44
Management of PID
Ceftriaxone 500 mg IM in a single dose PLUS Doxycycline 100 mg orally twice a day for 14 days WITH metronidazole 500mg orally twice a day for 14 days
OR
Cefoxitin 2 g IM and probenecid 1 g orally administered together at once PLUS Doxycycline 100 mg orally twice a day for 14 days WITH metronidazole 500 mg orally twice a day for 14 days
45
Cramping pain occurring with menstruation
Dysmenorrhea
46
Primary dysmenorrhea
occurs in adolescent women as a result of high levels of prostaglandin (pain begins after onset of menses and no pelvic pathology is identified
47
Secondary dysmenorrhea
Occurs in women >20 years; more likely associated with some form of pelvic disease
48
Management of primary dysmenorrhea
1. Prostaglandin synthetase inhibitors (start them on NSAID before periods start - ibuprofen, naproxen, indomethacin)
2. Oral contraceptive pills
3. Exercise
D. High fiber diet and reduction of sugar, caffeine and salt
49
Initial approach to vaginal bleeding
1. evaluate for pregnancy
2. Evaluate for uterine bleeding
a. non-uterine examples: cervix, vagina, urethra, anus
b. uterine bleeding indications: 1. coincident with bowel movement and wiping, occurs during or after urination and/or intercourse, is there vaginal, vulvar, perineal, or anal pain/irritation?
If not uterine: conduct pelvic exam
If uterine: determine using PALM-COEIN
50
What does PALM-COEIN stand for?
used for abnormal uterine bleeding
polyps, adenomyosis, leoimyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial causes, iatrogenic causes, not yet classified
51
Diagnostic tests for abnormal uterine bleeding
hCG (quantitative), prolactin, TSH, CBC, PAP, STD screening, Urinalysis
52
Medical management for PMS/PDD
bromocriptine, alprazolam, buspirone, TCA, clomipamine HCL, SSRI,atenolol, oral contraceptive pills, and progesterone
53
Dietary management for PMS, PDD
caffeine restriction, vitamin E, salt restriction, vitamin B6, exercise
54
What is abnormal metabolism of androgens and estrogen; results in ovarian cysts?
Polycystic Ovary Syndrome
55
What is the most common cause of infertility in women?
PCOS
56
Management of PCOS
lifestyle changes (diet and exercise), oral contraceptives for menstrual regulation, insulin-sensitizing medication (metformin), hair removal treatment, and acne treatment
57
Management of fibrocystic breast disease
warm soaks TID, low sodium diet, vitamin supplements, hormonal therapy, surgical intervention
58
When to being breast cancer screening?
May begin by age 40
59
How often to do breast cancer screening?
every 2 years after age 50 to 74
60
When to end breast cancer screening?
After age 75, if they have quality of life for >10 years, encourage it...with shared decision making
61
Average age of menopause is?
51 years, range from 45 to 55 years
62
True or false: menopause can result in atherosclerosis, CAD, osteoporosis, and changes in skin pigmentation
true
63
True or false: menopause can result in recurring UTIs and urinary urgency
true
64
Management of menopause
1. Estrogen therapy: provides most menopausal symptom relief for patients without a uterus due to a hysterectomy
2. Estrogen plus progestogen therapy: for women with a uterus to protect against endometrial cancer from estrogen alone
3. Encourage exercise, calcium supplementation, and health diet
4. non-hormonal tx of vasomotor symptoms: paroxetine (SSRI), vaginal lubricants and low dose vaginal estrogen
65
Contraindications for hormone therapy (menopause)
1. breast cancer
2. endometrial cancer
3. CAD/CHD (including hypertriglyceridemia)
4. venous thromboembolic disorders
5. active liver disease
6. unexplained vaginal bleeding
7. endometriosis and/or fibroids
66
Top 6 risk factors for osteoporosis
1. female, white, or asian
2. elderly
3. early menopause
4. estrogen deficiency
5. small frame or underweight
6. family history
67
What is normal DEXA score
T scores > -1.0 SD normal
68
what is osteoporosis DEXA score
below -2.5 is osteoporosis
69
What are some dietary sources of calcium?
dairy products, sardines, salmon with bones, green leafy vegetables, tofu, calcium fortified foods, take vitamin D (800-1000 IU/day)
70
supplements for osteoporosis
most common: calcium carbonate
shoult not be taken with high fiberfoods
avoid aluminum containing antacids
71
Drug therapies for osteoporosis
Estrogens, biphosphonates (alendronate, ibandronate, risedronate)
72
instructions for oral administration of biphosphonates
take with a full glass of water, NPO 30 minutes to 1 hour, sit upright 30 minutes to 1 hour
73
s/s fever, anorexia, weight loss, butterfly rash, periungual erythema, splinter hemorrhages, alopecia, joint symptoms
SLE
74
Laboratory/diagnostics for SLE
ANA + in 95% patients
antiphospholipid antibodies
anemia, leukopenia, and thrombocytopenia
75
management for SLE
1. mild symptoms: bed rest, midafternoon naps, avoidanceof fatigue
2. sun protection
3. topical glucocorticoid for isolated skin lesion
4. NSAIDs, hydroxychloroquine, glucocorticoids, and other therapies
